Impact Audit of D-Rev

ImpactMatters conducted an impact audit of D-Rev, a nonprofit that improves the health of poor patients by designing, developing and distributing affordable medical devices that meet the needs of resource-limited health hospitals and clinics.

The audit, published in September 2017, found D-Rev's medical devices have large impacts on patient health. Moderate quality evidence supports the estimate of impact. The audit assessed the quality of D-Rev's systems for monitoring program delivery, concluding systems are of moderate quality. Finally, the audit assessed D-Rev's systems for learning from data and iterating on its program design, finding D-Rev has exceptional systems for doing so.

Findings

Newborn Health And Mobility Programs

Mission

To improve the health of poor patients served by resource-limited medical facilities.

Problem

Medical devices on the market are too expensive for resource limited medical facilities.

Intervention

D-Rev designs, develops, licenses and distributes affordable medical devices that meet the needs of low-resource health facilities, including a phototherapy device for neonatal jaundice and a prosthetic knee.

Engagement

Number of devices effectively in use

Impact

Deaths and disabilities averted (reported in DALYs)

Impact and Cost

Approximately $600 per DALY averted

Impact and Cost Calculation

The impact of Brilliance is calculated using the number of patients treated over the device lifetime, the rate of reduction in kernicterus cases and the disability-adjusted life year (DALY) value of averting a case. The impact of ReMotion is the DALY reduction from untreated to treated limb amputations for the one month of ReMotion sales during 2013-15 period. In the average year from 2013-15, it cost $22 million to avert 38,000 DALYs. Of that cost, D-Rev paid $1 million and patients and hospitals paid $21 million.

Quality of Evidence

Quality of Evidence Assessment

D-Rev produces a phototherapy device (Brilliance) for neonatal jaundice and a prosthetic knee (ReMotion Knee). There is strong clinical evidence that phototherapy improves outcomes. However, D-Rev has weak internal evidence on whether Brilliance is administered correctly, who it is administered to and whether they would otherwise receive treatment. Strong clinical evidence shows that prostheses such as D-Rev’s ReMotion Knee improve outcomes. However, similarly to Brilliance, D-Rev has only low-quality internal evidence on its impact.

Organizational Effectiveness

Quality of Monitoring Systems

D-Rev’s monitoring systems are adequate and often very good. However, several of D-Rev’s systems have limitations that reduce accuracy. Most importantly, D-Rev only collects data from hospitals that are easy to reach and relies on assumptions about device use that may be out of date. As D-Rev delivers its devices through the market, data collection is challenging and costly.

Data Type

Credible

Actionable

Responsible

Transportable

Activities

Targeting

Engagement

Feedback

Outcomes

Corresponding Rating

Learning and Iteration

D-Rev has an exceptional research and development process. Over the last three years, D-Rev has considered four changes to the design of its program and adopted three. Decisions to implement changes were supported by high-quality data and were arrived at systematically. Furthermore, D-Rev regularly researches and reviews new changes.